Free flap microvascular anastomosis in head and neck reconstruction using a 4K three-dimensional exoscope system (VITOM 3D)

Virgilio, Armando De; Iocca, Oreste; Maio, Pasquale Di; Mercante, Giuseppe; Mondello, Tiziana; Yiu, Phil; Malvezzi, Luca; Pellini, Raul; Ferreli, Fabio; Spriano, Giuseppe

doi:10.1016/j.ijom.2020.01.022

Cited by 34 publications

(36 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…As shown in Table 2, there are increasing reports using digital microscope with 4K-3D camera since 2018 [2,10,11]. However, video microscopes with conventional 2K-3D cameras are still currently reported [12,13,14,15,16,17,18,19]. Notably, our report was the first utilizing a video microscope with 8K-UHD camera.…”

Section: Discussionmentioning

confidence: 78%

Mechanism and design of a novel 8K ultra-high-definition video microscope for microsurgery

Yamashita

Kobayashi

2021

Heliyon

View full text Add to dashboard Cite

The practical application of microscopes using 8K ultra-high definition (UHD) technology is progressing. However, due to insufficiencies in factors such as luminous intensity and stereopsis, it has not been possible to achieve sufficient image quality for close observation of submillimeter order microlymphatic anastomosis using a combination of 8K-UHD cameras with a rigid endoscope. We have improved the quality of microsurgery by the introduction of a new heads up 8K-UHD surgical system. Herein, we show the mechanisms of this next-generation technology that makes optical improvements to the electronic image input data, resolving the initial drawback. We have developed a new 8K-UHD digital microscope system with digital zooming to enable maximum 300X magnification of the surgical field. This system has specific lighting settings for shadows dropped in surgical field to expand the three-dimensional effect while still being a monocular camera. The original mechanism and design enable the increase of the depth of field with optimal angles between the imaging direction and approaching direction towards the surgical field. Assessment during a pre-clinical trial using rats demonstrated that it is possible to perform microlymphatic anastomosis in a heads-up position with a 70-inch 8K-UHD monitor and the 8K-UHD monocular camera system. Performing supermicrosurgery is difficult with conventional surgical microscopes. Our results illustrate the application of this new 8K-UHD microscope system to this new field.

show abstract

Section: Discussionmentioning

confidence: 78%

Mechanism and design of a novel 8K ultra-high-definition video microscope for microsurgery

Yamashita

Kobayashi

2021

Heliyon

View full text Add to dashboard Cite

show abstract

“…De Virgilio et al performed a clinical human study of free flap microvascular anastomosis using the VITOM 3D exoscope in 10 consecutive patients undergoing reconstruction after ablative surgery for head and neck carcinoma. Microvascular anastomoses were performed successfully using the exoscope in all patients, without any need for a conventional microscope [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

3D Exoscope-Assisted Microvascular Anastomosis: An Evaluation on Latex Vessel Models

Giorgini

Miralles

Tarsitano

et al. 2020

JCM

View full text Add to dashboard Cite

Background. Over the last few years, advances in technologies and digital imaging have led to the introduction of systems that enable a new approach to microsurgery and supermicrosurgery. The exoscope is a new magnification system that provides a 3D image of the surgical field: microsurgical procedures can be performed with the aid of this instrument. Here, we describe our preliminary experience with a high-definition 3D exoscope (VITOM®, Karl Storz, Tuttlingen, Germany), evaluating the characteristics of the instrument, and also its use as a magnification device for microanastomosis training. Methods. Six microsurgeons with various levels of experience were asked to perform three end-to-end anastomoses and two end-to-side anastomoses on latex vessel models, using, as a magnification system, the VITOM® 3D 4K exoscope. None of the surgeons involved had previous experience with the exoscope, with robotic surgery, with endoscopic surgery, nor with training simulators. Results. The results of the reported evaluation of the tool’s qualities, (VITOM Quality Assessment Tool) included: a good focusing of the surgical field; high image quality; strong luminance; good magnification; clear stereoscopy; and excellent freedom of movement. The exoscope proved to be user-friendly. A constant reduction in the time needed to perform the microsurgical anastomosis at each exercise was recorded. Among other advantages were the easy switching from the magnified image to the macroscopic view, superior ergonomics allowing a relaxed posture while performing the anastomosis, adequate space, and a convenient setting for the assistants to view the operating field. Conclusions. Our study showed that the exoscope VITOM 3D can be successfully used as a magnification tool for microsurgical anastomosis on synthetic vessels, and that it can also be helpful during training courses in microsurgery.

show abstract

“…When the 3D-HD system of vision is employed in particular settings, as for oral cavity or oropharyngeal lesions [ 9 ], or reconstructive surgery [ 10 ], or otoneurosurgery [ 11 ], where micromanipulator for the CO 2 laser is not needed, traditional cold instruments, monopolar scalpels, or fiber lasers can be employed as cutting devices. The disposition of the nurse’s master table and secondary table, as well as the anesthesia device or other surgical devices in the operatory room, is not further influenced by the application of this setting and is totally similar to a traditional procedure.…”

Section: The Vitom® 3d-hd Exoscopic Systemmentioning

confidence: 99%

“…This system is broad suitable also for otoneurosurgical, [ 11 , 14 ], neurosurgical [ 15 ] and reconstructive procedures [ 10 ], being its unique limit the coupling with the CO 2 laser micromanipulator, required for transoral laser microsurgery, that we managed with the above-mentioned coupling system.…”

Section: Perspectivesmentioning

confidence: 99%

Microsurgical procedures during COVID-19 pandemic: the VITOM® 3D-HD exoscopic system as alternative to the operating microscope to properly use personal protective equipment (PPE)

Carobbio

Filauro

Parrinello

et al. 2020

Eur Arch Otorhinolaryngol

View full text Add to dashboard Cite

Purpose In the field of microsurgery, the use of conventional operating microscope, adopted in several disciplines, is not suitable with the full adoption of appropriate personal protective equipment (PPE), as goggles and face shields, needing the eyes to be at close contact with oculars. Methods Herein we present an exoscopic surgical setup, implemented for transoral laser microsurgery, by the VITOM® 3D-HD system. Results Our proposed exoscopic setting overcomes safety limits of the conventional operating microscope, being suitable with the adoption of full PPE necessary facing with suspected or confirmed positive SARS-CoV-2 patients needing urgent microsurgical procedures. Conclusion The use of protocols to reduce the virus spreading is mandatory to safely treat also patients potentially SARS-CoV-2 infected. The described surgical setup is advisable to manage urgent microsurgical procedures along the duration of the COVID-19 pandemic, being applicable PPE necessary to treat potentially or confirmed SARS-CoV-2-infected patients.

show abstract

Free flap microvascular anastomosis in head and neck reconstruction using a 4K three-dimensional exoscope system (VITOM 3D)

Cited by 34 publications

References 7 publications

Mechanism and design of a novel 8K ultra-high-definition video microscope for microsurgery

Mechanism and design of a novel 8K ultra-high-definition video microscope for microsurgery

3D Exoscope-Assisted Microvascular Anastomosis: An Evaluation on Latex Vessel Models

Microsurgical procedures during COVID-19 pandemic: the VITOM® 3D-HD exoscopic system as alternative to the operating microscope to properly use personal protective equipment (PPE)

Contact Info

Product

Resources

About